Educational Cases

July 2015 Spotlight Case of the Month
Submitted by:  Saabry Osmany, MD
HISTORY: A 59 year-old female presented for imaging with a history of pancreatic neuroendocrine tumor with liver metastasis.
IMAGE FINDINGS:  Images of all performed near the same timepoint.  A: Fused Ga-68 DOTATATE PET/CT;  B: Ga-68 DOTATATE PET Only; C: Fused FDG PET/CT; FDG PET Only, Image 1:  The arrows are pointing at the primary pancreatic tail tumor/mass and demonstrates some FDG activity but marked avidity for Ga-68-DOTATATE.   Image 2: The arrow is pointing at one of the hepatic metastatic lesions with central necrosis, no FDG avidity, and peripheral Ga-68 avidity.  Image 3:  Nonenhanced CT shows multiple hepatic metastases.
DIAGNOSIS:  What is the likely cause of the different uptake pattern in the tumor for the two radiotracers utilized?
IMAGES:  Please see images on IMAIOS website

May 2015 Spotlights Case of the Month
Submitted by:Twyla Bartel, DO, MBA, FACNM
HISTORY: This is a 15 year-old female with a history of three prior embolizations of a cerebral AVM. She developed a persistent headache after the most recent embolization procedure. What is the likely cause of uptake on the brain flow study? Please see the case

January 2015 Spotlights Case of the Month
This month’s case was contributed by Dr. Manohar Kuruva.  History:  A 46 year-old female had undergone regadenosan stress myocardial perfusion imaging with 99mTc tetrofosmin.  What is the diagnosis?   Please respond and send your answer to acnm@acnmonline.org before 1-16-15.  The winner will be announced in March issue. Click Here to access the Interesting Case - January 2015.

November 2014 Spotlights Case - 79 year-old male with worsening neurological problems
Submitted by: Asim Bag, MD
A 79 YO right handed white male patient presented with worsening language problem and new onset of seizures. He was diagnosed with MGMT promoter region methylated glioblastoma multiforme 7 months before the current presentation that was treated by near total resection followed by concurrent chemoreduation using standard Stupp protocol. Radiation treatment was completed 4 months before current presentation. His base line post radiation MRI was obtained 1 month after completion of the radiation treatment (Figure 1). An MRI was repeated 2 weeks ago (Figure 2), which demonstrated change from the baseline scan. An FDG PET scan was performed (Figure 3) after the clinic visit for further work-up.  What is the diagnosis?  See the figures in a pdf here.

September 2014 Spotlights Case - 60 year-old female with flank pain
Submitted by:Twyla Bartel, DO, MBA, FACNM
HISTORY: 60 year-old female with bilateral flank pain off and on for two months with associated fevers, chills, nausea, and vomiting.  She denies gross hematuria.  There is laboratory evidence of a urinary tract infection.  She has a history of renal stones with several interventions, the last approximately 10 years ago.  The kidney stones were calcium oxalate and struvite stones. See the whole case in PowerPoint form here.